Dutch Lockdown, original version

Note: This has not been fact-checked. Any discrepancies, go with the original version where available, or check against primary sources. Differences may be because figures were updated.

Across a small square from the Mint Tower, where the Dutch Republic manufactured coins for a time starting in 1672, begins Kalverstraat,  one of the busiest shopping streets in the Netherlands. Brands from H&M and Topshop to Camper, Nike, and Vans to Swatch and Swarovski all maintain stores here, and on a normal—that is to say, pre-Covid-19—Saturday, almost 7,000 people an hour would throng the pedestrian thoroughfare .


The morning of May 15, of course, was different. Almost all the stores were open, but shoppers were nearly outnumbered by construction crews taking advantage of the reduced traffic to make improvements. Among them was  Gerard Zandbergen, CEO of Locatus, a Dutch research house that provides data on the Benelux region and major European cities to customers such as banks, apparel brands, and government agencies.


“Our clients want to know how many people pass by their store each hour and each day, and how many come in,” Zandbergen says, sipping a take-out coffee outside the Begijnhof, a courtyard dating to the 14th century. Sensors strategically positioned along major shopping areas around Europe—we just passed one—vacuum up signals from passing phones searching for WiFi base stations to connect with.


The company anonymizes and analyzes these signals to determine how many people move through a particular location at any given time. It’s mobility data similar to what Google and Apple have been making available sinceCK SARS-CoV-2 struck , but in greater detail in terms of both time and space.


On March 12, fourteen days after the first Covid-19 case was diagnosed in the Netherlands, Prime Minister Mark Rutte held a press conference at which he asked—asked, not ordered—everyone in the country to work from home as much as possible. Two days later, Locatus data showed that foot traffic in busy retail streets, such as Kalverstraat, dropped by roughly 80 percent. In Paris and Madrid, after national governments instituted mandatory stay-at-home measures, foot traffic on destination shopping streets fell 90-to-95 percent, Zandbergen tells me.


But over where I live in De Pijp, along Ferdinand Bolstraat, in front of the neighborhood Albert Heijn grocery store, Kruidvaat health and beauty shop (basically CVS without the prescriptions) and Simon Levelt specialty coffee and tea franchise, it was a different story. Neighborhood commercial streets in the Netherlands have seen little change in foot traffic since Rutte’s request. “People still need to eat and take care of themselves,” Zandbergen says.


Allowed to, the Dutch did so responsibly, by and large. Shopkeepers rearranged shelves and affixed construction-site tape to guide customers through the aisles so they could keep a safe distance from each other. The number of people allowed in at a time is limited by the number of the shopping baskets available.


Employees at most places stand by the door to make sure everyone takes one. Signs on the door inform customers of the rules and ask them to “take care of each other” inside, and shoppers will stand aside to let another pass so they don’t come too close. All this was quickly improvised in the first couple of weeks after Rutte’s request. Name TK, the owner of the Simon Levelt where I buy my coffee, says business is actually up since the lockdown—even as his delivery service to offices has shuttered. “Nobody’s getting their coffee at work right now,” he says with a smirk.


While New York, San Francisco, Milan, Munich, Tel Aviv, Rio de Janeiro and virtually every other major city on Earth became virtually unrecognizable during the most restrictive phases of their respective responses to the coronavirus pandemic, Amsterdam looked very little like them. Children in Spain were not allowed to leave their homes for six weeks. Residents of Paris needed to fill out a form explaining their reason for being outside and carry it with them whenever they left home, or face a fine.


Though traffic in Amsterdam is reduced, I still needed to dodge pedestrians, bikes, cars, delivery vans and trams on the way to Kalverstraat to meet Zandbergen. Twelve weeks in to the outbreak here, the Netherlands has not seen one day of the strict lockdowns common to so many other countries, in Europe and elsewhere.

“Controlled distribution among groups that are least at risk is our scenario of choice,” Rutte said in an address to the nation March 15. The plan was to “build up population immunity.” In Europe, only Sweden has instituted fewer closures and restrictions.


It’s a risky strategy, according to some experts. “You have to be vigilant,” says Eileen Choffnes, the immediate past director of the U.S. National Academy of Medicine’s Forum on Microbial Threats and now a consultant on emerging infectious diseases, such as SARS-CoV-2. Allowing some spread, she maintained, is tantamount to allowing some people to die. “They’re letting the virus run loose,” Belgian minister of public health Maggie de Block told Brussels newspaper De Morgen. “I think it’s a dangerous approach.” (She declined an interview request, citing the need to focus on the outbreak response.)


But the mitigation phase of the Dutch response to coronavirus has largely worked: The Netherlands had among the world’s briefest peaks in new cases, the doubling rate slowing from five days on March 26 to 11 days within 2 weeks and continuing to fall, even as testing accelerated. Daily new hospitalizations have fallen from 610 at the peak, on March 28, to an average of 7 during the second full week of May[UPDATE BEFORE PRESS].


Though the mortality rate has increased by half, compared to the same period last year, the jump is less than in Belgium, Italy, or Spain, all of which had stricter measures. Sweden’s death rate is less than the Netherlands’, but it’s much higher in the dense urban centers of Stockholm and Malmö, and dropping back to normal levels more slowly than here. Dutch ICUs never maxed out, and are empty enough now that regular non-elective surgeries have recommenced.


The Netherlands has both flattened the curve and kept life tolerable. Perhaps the Dutch way, between the mandatory stay-at-home orders of Italy, France and Spain at one extreme, and Sweden’s remaining open almost entirely, will prove to have been best.


And as U.S. states and countries abroad relax their restrictions, the Dutch approach to re-opening—what Rutte has described as the “transition” phase—may prove instructive.

***

Rutte’s government was slow to respond to Covid-19. France reported the first case of the novel coronavirus in Europe on January 24, suggesting that China’s insistence 10 days earlier that there was no clear evidence of human-to-human transmission was not to be trusted. A Belgian on an evacuation flight from Wuhan to the Netherlands was diagnosed February 4; it could be safely assumed, at that point, that SARS-CoV-2 was in the country. Yet Rutte allowed Carnival celebrations to continue the weekend of the 21st, with revelers crowding into stifling bars throughout the largely Catholic south of the country.


It wasn’t until March 9 that Rutte, of the center-right People’s Party for Freedom and Democracy, which leads a coalition government in the Netherlands’ multi-party system, advised against shaking hands and advised people in the province with nearlyCK all the cases at the time, Noord-Brabant, to work from home if possible. The country already had almost 500 cases. Three days later, the work-from-home advice was extended to the rest of the country. Rutte banned events of more than 100 people at least until the end of the month, and asked medical professionals not to leave the country. On the 15th, after resisting for weeks calls to close the schools, which Belgium had done on the 12th, Rutte flip-flopped, having found a way to keep some of them open as day-care facilities for young children of essential workers, such as those in health care and police and fire protection. More than three people not of the same household were required to keep a 1.5 meter distance, which the Outbreak Management Team advising Rutte—epidemiologists, medical doctors, and public health experts who stand ready to mobilize when needed—had decided is safe. (It’s still in place, enforced by an uncompromising €390 fine.) Cafés, bars, restaurants, gyms, any profession requiring contact or close proximity to customers, such as dentists and hairdressers, and—this being the Netherlands—brothels and marijuana stores were required to close within the hour. But stores—not just “essential” ones like groceries, pharmacies, and gas stations—could remain open, along with parks and beaches.


The Netherlands was opting for what Rutte has termed an “intelligent lockdown.” “We will continue to search for the balance between taking the necessary measures and allowing ordinary life to continue as much as possible,” he said in a nationally televised address, the first by a Dutch Prime Minister in 47 years. “How can you ensure that [restriction] is so limited that society can function as normally as possible? Each of these measures has a price: in people's personal lives, of course, [and] also in society. We must always try to find a good balance.”


These guiding principles—to allow people to go out, but trust them to practice safe distancing—were asking a lot of Rutte’s constituents. Not even the Vice President of the United States complied with a request from officials at the Mayo Clinic, in Minnesota, to wear a mask to cover his nose and mouth when he visited there in April. Neither did many visitors to Yellowstone National Park, after it re-opened in May, heed the advice. But in the Netherlands, people have largely stuck to Rutte’s recommendations, a practice that may be uniquely Dutch.


“The whole plan relied upon public support,” says Daan Roovers, a medical doctor, professor of philosophy at the University of Amsterdam, and the “thinker of the fatherland” (an unofficial title bestowed by Philosopher magazine and the newspaper De Trouw). As other lifelong residents had told me, she says, “When you impose a rule in the Netherlands, there will be a lot of resistance—we’re not that obedient. So if you leave people a little room to maneuver for themselves, to think for themselves, you’ll gain more support and it will be more successful.”


This is grounded in Dutch history, and, to the extent such a thing can be said to exist, the national character. Bas Heijne, a columnist for Amsterdam newspaper NRC who lives part-time in Paris, says that France “is very much about procedures—the ornament, the ritual of bureaucracy.” He needs to print out about 10 forms just to leave the house. “It’s much more authoritarian.” Whereas in Holland, he says, “The attitude toward the crisis was much more talking about people’s own responsibility—it must all come from the inside, not from rules.”


Indeed, Rutte said on March 12, “We can only solve this together. I want to call on everyone to keep an eye on one another. Help each other where possible.” Automated announcements on the Amsterdam Metro every few minutes implore riders (in Dutch and English) to keep a distance of 1.5 meters, “and look after each other.” In France, Heijne says, “people don’t know their neighbors, and they don’t want to know their neighbors—so they can be left alone by their neighbors. In Holland, it’s a completely different attitude.”


“Everybody here understands that sometimes you really have to do something together,” says historian Geert Mak, author of In Europe: Travels Through the 20th Century. This goes back to the 11th century, when Netherlanders started banding together to drain bogs and beat back the ocean to reclaim land that was then divided among the volunteers as farms.

Sacrificing a measure of freedom to achieve a shared goal in this way enabled the exercise of a greater freedom. Unlike in the U.S., where individual rights reign supreme, Netherlanders seem to understand that freedom to can limit freedom from.


Under the intelligent lockdown, people could be trusted to stay home, because they wouldn’t want their own freedom to go shopping on Kalverstraat to impinge on someone else’s (or their own) freedom from illness. “The freedom of one person cannot be at the expense of the health of another,” Rutte said on April 21, announcing that primary schools would soon be re-opened. (The cheers of children inside their apartments could be heard from inside mine.) Nine out of ten Dutch people said in March they were “willing to give up some of their individual freedoms to keep the coronavirus from spreading,” according to polling by Motivaction and the WIN/Gallup network.


It comes down to trust. 79 percent of Dutch people in the Motivaction poll agreed with the statement, “The government is taking good measures to control the virus,” compared to 52 percent in France and less than half in the UK and Germany. This despite many more Netherlands citizens expecting they or someone in their immediate family would contract the disease.


“We trust the government to do the right thing, and to tell us to do the right thing,” says Bart Stubenitsky, a doctor with a side-hustle in a small American biotech firm, Breonics. Even if the party he supports is not in power, he says, “I still believe that what they’re doing is for our good.”

***

No economists or business interests sit on the Outbreak Management Team, and neither its letters of advice to the health minister nor his written explanations to parliament of his policy recommendations indicate economic or long-term health effects were taken into consideration when deciding how the government should fight coronavirus. (And they don’t discuss their internal deliberations with the press.) But Netherlands’ GDP fell 1.7 percent in the first quarter, compared to 4.8 percent in the U.S.


As the intelligent lockdown benefits the economy in the short term it will therefore benefit Dutch health in the long term, which will in turn benefit the economy in the long term. Because strict lockdowns will likely produce social, economic, health, and mental health consequences that won’t be felt for years or even decades.


A growing body of evidence in the emerging field of life-course research supports this. In short, adult health and disease risk is linked to exposures and experiences in childhood and even gestation. If your mother had poor nutrition during her pregnancy, you’re at greater risk for cardiovascular disease. It doesn’t stop at the heart: In 1998, a vicious ice storm descended upon Quebec, knocking out electricity for four million people for four days, longer yet for many of them.


Researchers followed the children of women who were pregnant at the time, and found they experienced lower birth weights—a predictor of lifelong health problems—and lower fine motor skills, a predictor of lower school performance in the early grades. As teens, they were more prone to anxiety and depression, which affect physical health and earning potential—depression being the leading cause of disability worldwide, according to the WHO.


Governments that instituted strict lockdowns will likely be bearing related costs for decades. It’s expected, given her background, that Choffnes would chide Rutte’s response, but she is only looking at outbreak mitigation through the lens of microbial threats. A hardcore lockdown saves lives at risk from Covid-19, but it also means people will die of other causes, just later. Leaders in other countries seem to be deciding that politically, it’s easier to ignore the problem that will appear in 2, 20, or even 60 years with no obvious direct precursor, than the one in front of you today.


Health minister Hugo De Jonge apparently understood this when he wrote, in an April 7 letter to parliament explaining his recommendations to Rutte, “What we do now for health will also contribute to the economic recovery. Which is no contradiction—these are two side of the same coin.” (It is an indicator of the political comity here that after his predecessor, Bruno Bruins, collapsed from exhaustion on the floor of parliament on March 19, de Jonge, a member of an opposition party, was elevated to the post. At the peak of a crisis.)


The Netherlands can afford to take a softer approach to coronavirus because it has more health capital in its population. Like a business that’s been ordered closed and needs to draw on financial reserves to stay afloat, Dutch people struck by Covid-19 have more health reserves going in to their bout of illness, being less likely to be afflicted with the underlying the health conditions that are disproportionately represented among serious cases and deaths.


“The first thing you notice when you land in Amsterdam is that people are tall,” says Dr. Neal Halfon, director of UCLA’s Center for Healthier Children, Families and Communities, who has consulted on children’s health and social welfare programs in the Netherlands. “It has to do with the fact that its kids are thriving.” In UNICEF’s cross-national comparisons of the health, development, and well-being of children, the Netherlands always ranks near or at the top. Across all age groups, the rate of obesity, which has been linked to worse outcomes from Covid-19, is 13 percent, compared to 40 percent in the U.S., and the smoking rate is lower than in 25 U.S. states (including every rural and Southern one). “You’re starting in a better place, with more resources and more capacity to draw on,” Halfon says.


The spread of death from Covid-19 according to age in the Netherlands reflects this: Just 22 of 5,748 recorded deaths are of people under 50, or 0.003 percent[UPDATE BEFORE PRESS]. It’s 2.6 percent for under-45s in the entire US. In New York City, it’s 4 percent for under-45s.


New York’s brutal experience of coronavirus is likely tied to its high levels of poverty and inequality, says Dr. Otis Brawley, distinguished professor of epidemiology at John Hopkins University’s Bloomberg School of Public Health (named for its primary funder, the owner of this magazine’s publisher). The death rate is almost double in the poorer, minority-majority Bronx than in Manhattan, the whitest and wealthiest borough. “Mortality goes up dramatically with co-morbid conditions” common among minorities and those in poverty, Brawley says, such as hypertension, diabetes, and obesity. “That makes it a perfect storm in the US for hitting minorities.”

***

Brawley fears that with states loosening restrictions too soon—in early May, not one state that had lifted stay-at-home orders met the Trump administration’s guidelines for doing so—SARS-CoV-2 will soon strike rural communities with few hospitals and clinics.


As many have said, but few U.S. governors have heeded, universal testing of suspected cases and contact tracing of those testing positive is essential to the successful removal of restrictions. “If you don’t have that system in place as you relax physical controls and open the economy, whatever progress you’ve made in containment or mitigation will be lost,” Choffnes says. Regional health agencies in the Netherlands have been hiring people to do testing for weeks, and the nation exceeded the WHO benchmark for testing rate on May 6. Rutte lifted some measures on May 11. Primary schools were allowed to re-open on the condition that they alternate groups of half the kids. My younger daughter’s school added its own measures, such as staggering the children’s entry and exit and affixing yellow tape to hallway floors and making sure children walk to the right of it. Others require hand-washing between classes. Hairdressers and dentists (but not prostitutes) are back in business, taking extra precautions.

Some library branches are open in Amsterdam. Locatus shows foot traffic on Kalverstraat back to almost half of pre-pandemic levels.


The plan is for movie theatres, restaurants, and museums to re-open, with limited capacity, on June 1, assuming no late-May spike resulting from the limited re-openings, with gyms, concerts and sports events to follow on September 1.

“We do this as quickly as possible, but no faster than is responsible,” Rutte said. “Caution now is better than regret afterwards. The warning that applies to everything we say today: We can only unlock the Netherlands if everyone continues to behave wisely and adhere to the rules of conduct.”

That will be a challenge. “There’s going to be an enormous amount of traffic on the streets,” predicts Martijn Potgiesser, owner of the pizza place on my corner, Pizzakamer. “More than last summer, because of pent-up demand.”

That will be true everywhere, including the US. But with a healthier population, far less poverty, and greater social cohesion, the Netherlands will be better prepared to prevent a second wave, quash one should it appear, and withstand it if they fail. And it’s safe to say the Dutch will work toward keeping these factors in place for when the next pandemic comes.  

 

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